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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400618
Report Date: 05/14/2024
Date Signed: 05/14/2024 03:11:33 PM

Document Has Been Signed on 05/14/2024 03:11 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:WARREN FAMILY CHILD CAREFACILITY NUMBER:
198400618
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 5DATE:
05/14/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Licensee/ Riley WarrenTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analysts (LPA's) Susann Sanchez and Ashley Calderon conducted an unannounced case management inspection for an increase in capacity. LPAs met with Licensee Riley Warren who guided LPA with a guided tour of the inside and outside of the facility premises. During today's visit there were 2 infant and 3 children present with the Licensee when LPAs arrived. Facility capacity is in compliance for a Small Family Child Care Home. Per Licensee, hours of operation will be Monday through Sunday from 12:00AM to 11:59PM and LPA's informed Licensee care cannot exceed 24 hour care at one time. Licensee states that she will care for children Infants -12 years of age.

This is a two story home. The home consists of 4 bedrooms, 3 restrooms, living room, kitchen, day care room, backyard, garage, and front yard. Areas that are accessible to children include: one bathroom, day care room, part of the living room, and backyard. Areas off limits to children and parents include: All bedrooms upstairs (4) and bathrooms (2), kitchen, half of the living room, garage, and front yard.

At 1:00pm, upon arrival, LPA's noticed at the entrance of the front of the house on the left hand side a fountain/pond. Fountain/pond did not have running water but had water inside the pond area and LPAs measured fountain at 3ft. 8 inches wide and .8 inches deep. A Type A deficiency was given and an immediate civil penalty violation was provided. Facility sketch provided for capacity increase application did not state bodies of waters present at the above home. Licensee stated she was unaware that fountains and spas needed to be reported. Licensee immediately emptied fountain pond. Photos were taken.

Outside area was observed to have age appropriate toys and observed for safety for children in care. At 1:20pm, LPA's noticed a secured latched clsoed and covered jacuzzi. Both bodies of waters were not reported to Licensing. Per Licensee, jacuzzi was gifted spa less then a year ago. Type B was cited for reporting requirements. Photos were taken.

(Page 1, Continuation on LIC809-C...)
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 05/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/14/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: WARREN FAMILY CHILD CARE
FACILITY NUMBER: 198400618
VISIT DATE: 05/14/2024
NARRATIVE
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Areas used by children were inspected for safety, comfort, heating, cleanliness and telephone service. The home has central air and heating. Applicant was advised that if any poisons are purchased, it is required to be locked with a key or combination lock.

Per Licensee, there are no pets, firearms, and weapons on the premises. LPA's observed age appropriate toys and napping equipment for children. LPA observed electrical outlet covers throughout the facility. Smoke and carbon monoxide detectors were tested and are operable.

The following was sent to LPA via email:
- Updated Mandated Reporter (expires 05/01/26)
- Updated CPR and 1st Aid (expires 05/2026)

An updated sketch needs to be submitted by 05/21/24.

Based on the LPA’s observations, the following deficiencies were cited on the attached LIC 809D (deficiency page), Civil Penalty was given on LIC421IM and are being cited in accordance with California Code of Regulations Title 22, Division 12, Chapter 1 and Section CCR & H&S.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit.

Once all corrections are complete, LPA will submit application for final review. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Riley Warren and appeals were provided.

(Page 2, End of Report)
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 05/14/2024 03:11 PM - It Cannot Be Edited


Created By: Ashley Calderon On 05/14/2024 at 01:31 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: WARREN FAMILY CHILD CARE
FACILITY NUMBER: 198400618

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/15/2024
Section Cited
CCR
102417(g)(5)

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(g) The home shall be free from...conditions which might endanger a child. Safety precautions... (5) All licensees shall ensure the inaccessibility of pools..., fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence.
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During time of visit Licensee immediately emptied out fountain water and a declartion letter was collected form Licensee stating fountain will remain empty. Licensee will update facility sketch(s) and send a copy to LPA Sanchez by due date of 5/21/24.
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This requirement is not met as evidenced by: Based on interviews & observation, a fountain in the front was osberved filled w/ water. Licensee stated not knowing having to report bodies of water.This poses an immediate health and safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Valarie Cook
LICENSING EVALUATOR NAME:Ashley Calderon
LICENSING EVALUATOR SIGNATURE:
DATE: 05/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/14/2024


LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 05/14/2024 03:11 PM - It Cannot Be Edited


Created By: Ashley Calderon On 05/14/2024 at 02:21 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: WARREN FAMILY CHILD CARE
FACILITY NUMBER: 198400618

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/15/2024
Section Cited
CCR
102416.2(a)

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102416.2(a) Reporting Requirements (a)The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm). The requirement was not met as evidenced by:
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Per Licensee understands that reporting requirements are important and stated to the LPA that she understands that all changes to the faclity need to be reported that affect her facility must be reported to the department within 24 hours.
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based on interviews conducted with License. Licensee admitted that she did not report that facility has a jacuzzi in an "on limit" area. This poses a potential risk to the health and safety of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Valarie Cook
LICENSING EVALUATOR NAME:Ashley Calderon
LICENSING EVALUATOR SIGNATURE:
DATE: 05/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/14/2024


LIC809 (FAS) - (06/04)
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